History of Medical Ethics

PH 350Norwich University

Spring 2010

Learning Objectives• To understand early medicinal thought,

especially the concept of paternalism• To highlight some of the major events in

history that developed patient autonomy• To review the goals of medicine• To understand the major principles of

modern-day medical ethics

Early Medicinal Thought• Paternalism

-Medical treatment as a father/child relationship

-Guiding principle: physician decides what is best for the patient and tries to follow that course of action

-Focus: patient care and outcomes, not the patient’s needs or rights

-Argument: maximum patient benefit can only be achieved when the doctor makes the final decision

Paternalism…Continued• Types of Paternalism

-Positive vs. NegativePositive = promotes the patient’s goodNegative = seeks to prevent an existing harm

-Soft vs. HardSoft = appeals to the patient’s valuesHard = applies another’s values over the patient

-Direct vs. IndirectDirect = benefits the patient who has been restrictedIndirect = benefits a person other than the one restricted

The Father of Medicine• Hippocrates

-Rejected medical views of his time

-Based his medical practice on observations and study of the human body

-Believed that illness has a rational explanation

-Treated body as a whole unit, not just parts

-Founded a medical school on the island of Cos, Greece to teach his beliefs

Hippocratic Oath• Original vs. Contemporary

-language and content has been updated to fit modern beliefs about medicine

-spells out physician responsibilities to both the patient and the medical profession

Evolution to Autonomy• Making the shift from paternalism

-Patient given opportunity to determine benefit vs. harm- The Patient’s Bill of Rights

-Questions being raised regarding the patient’s wishes as to what is ethical

-How much do you tell the patient?-Do they even want to know?

Notable Cases in History• Nuremberg Code: 1946

-Limits on medical research following Nazi testing of hypothermia & antimicrobialagents

-Subjects were put in ice tanksfor 3 hours, wounds were inflicted& purposely infected with bacteria

-Concepts of informed consent, avoiding all unnecessary physical & mental suffering, proper preparation & facilities, ability for subjects to opt

out, basing human experiments on results of animal testing

Notable Cases…Continued• Tuskegee Syphilis Study: 1929

-Use of placebos in studies

-Participants were illiterate, black sharecroppers thoughtto have “bad blood”

-Deaths, chronic illness, andtransmission to wives & childrenresulted

Notable Cases…Continued• Nancy Cruzan: 1983

-Was maintained in a persistent vegetative state for several years -Parents requested that artificial hydration and nutrition be withdrawn

-Courts rule in their favor, but healthcare team appeals the decision

-Incompetent patients need to be protected by law

-Encouraged the development of advance directives and appointmentof a health care proxy to carry out patient’s wishes

Goals of Medicine • Relieve suffering- Example: The use of Chloroform and Ether

Chloroform was used more often because it was faster acting, less was needed to put someone under, and it was non-flammable. However, it was more dangerous than using Ether. The risk of drug overdose was greater with Chloroform.

Goals…Continued• Promote health

- Flintstones Vitamins

- Acne Treatment

- Weight loss

Goals…Continued• To cure disease and preserve life

1900 – Average life expectancy was 492003 – Average Life expectancy is 78

• Vaccinations Definition: “A preparation of a weakened or killed pathogen, such as a bacterium or virus, or

of a portion of the pathogen's structure that upon administration stimulates antibody production or cellular immunity against the pathogen but is incapable of causing severe infection.”-Swine Flu

• Cures- Breast Cancer

Principles of Medical Ethics• Confidentiality

-HIPAA (Health Insurance Portability & Accountability Act)

• Honesty-Telling patients what they need to know

• Justice-Treating all patients without discrimination

• Gatekeeping-Patients access to medicine through doctors

• Report impaired colleagues

Principles…Continued• Avoid sexual relations with patients

• Conflicts of interest

• Scope of practice-Range of responsibility, abilities

• Gaming the system-Using patients to make more money

Thank you to all of our viewers!

The End

Produced by:J. Bielski, H. Black, V. Bruce, & J. Davis